Paediatric diagnostic reference levels for common radiological examinations using the European guidelines

Abstract

Objective: The purpose of this study was to explore the feasibility to determine regional diagnostic reference levels (RDRLs) for paediatric conventional and CT examinations using the European guidelines and to compare RDRLs derived from weight and age groups, respectively. Methods: Data were collected from 31 hospitals in 4 countries, for 7 examination types for a total of 2978 patients. RDRLs were derived for each weight and age group, respectively, when the total number of patients exceeded 15. Results: It was possible to derive RDRLs for most, but not all, weight-based and age-based groups for the seven examinations. The result using weight-based and age-based groups differed substantially. The RDRLs were lower than or equal to the European and recently published national DRLs. Conclusion: It is feasible to derive RDRLs. However, a thorough review of the clinical indications and methodologies has to be performed previous to data collection. This study does not support the notion that DRLs derived using age and weight groups are exchangeable. Advances in knowledge: Paediatric DRLs should be derived using weight-based groups with access to the actual weight of the patients. DRLs developed using weight differ markedly from those developed with the use of age. There is still a need to harmonize the method to derive solid DRLs for paediatric radiological examinations.

Comparison of typical radiation doses and risks using an anthropomorphic ‘bone fracture’ phantom for commonly performed X‐ray projections in a 5‐year‐old

“…These doses were presented for each projection in Table 3 and were compared to international patient‐based DRLs published by Almen et al. in Table 4 5 …”

“…ICRP Publication 135 recommends that paediatric X‐ray DRLs are calculated according to weight, rather than age 2 . A Scandinavian group compared regional DRLs to European, French and Irish DRLs with limited success due to insufficient numbers in the weight bands 5 . As the 5‐year‐old phantom used in this study is a standard‐sized phantom weighing 20 kg, it falls within the middle weight band of 15–30 kg recommended by the ICRP.…”

“…Comparison of results of this phantom study to international DRLs for chest X-ray and abdomen X-rays 5. …”

Dual-Layer Detector Head CT to Maintain Image Quality While Reducing the Radiation Dose in Pediatric Patients

“…As DLCT scanning parameters in this study, a tube voltage of 120 kV, a current of 250 mAs, a DLP of 717.47 (SD, 41.52) mGYÂcm, and a CTDI vol of 36 mGy were used for conventional CT to view the pediatric brain, which were similar to or slightly lower than diagnostic reference levels for the CT radiation dose in China (804 mGy for the DLP and 39 mGYÂcm for CTDI vol ) 28 and other countries. [29][30][31][32][33][34] The CTDI vol is the dose of the standard American College of Radiology head phantom according to the reference phantom selection in pediatric CT; 19,35 the DLP is the actual radiation dose received by the patient. There was no significant difference in DLP between the 6 year and younger and older than 6-year subgroups in the 250-mAs group, while there was a significant difference in DLP between the 6 year and younger and older than 6-year subgroups in the 180-mAs group.…”

Reporting Diagnostic Reference Levels for Paediatric Patients Undergoing Brain Computed Tomography

“…For the investigation of the radiation doses, each paediatric CT imaging department participating in the NDRL survey should compare their median radiation dose quantity against the NDRLs. When the median radiation dose quantity exceeds the derived NDRL standard, the paediatric CT imaging centre should employ all applicable measures to optimize the CT radiation dose by changing the department paediatric protocol or upgrading their CT scanners [6][7][8].…”